Birth centers can give women a new choice

The number of NYC birth centers is growing with the recent opening of one new hospital birth center, and, in coming months, one new freestanding facility.

Birth centers have not been able to keep up with demand. Women in New York State are seeking alternatives to hospitals, with data showing that out-of-hospital births have risen by 68 percent between 2005 and 2013 -- 1,085 more out-of-hospital births. With birth-center care sought by women and research showing that centers provide quality and cost-effective care, it's time to make more options available to the 230,000 women giving birth a year in our state.

New York lags behind other states, with just two existing freestanding birth centers -- one in Brooklyn and one in Buffalo. California has 24 freestanding birth centers, Texas has 62, and Florida 29.

The centers provide a supportive environment, report excellent health outcomes, and have Caesarean-section rates just one-fifth of hospitals. More must be done to improve access, particularly to ensure that centers are available to women in underserved communities. NYC's only birth center in a safety-net hospital, Bellevue, has been shuttered for six years. Its only center in a community health facility, in the Bronx, remains open for prenatal and postpartum care, but doesn't assist births. State law makes it difficult to open and operate freestanding birth centers.

Proposed state legislation would enable midwives to open and direct birth centers by creating a new facility category -- a midwife-led birth center. The designation would require development of regulations specifically designed for and appropriate to birth centers based on nationally recognized standards.

Currently, New York's birth centers are regulated as diagnostic and treatment centers. Technical, bureaucratic obstacles, like hallway sizes and the requirement of a physician medical director, have imposed significant costs that get in the way of sustaining freestanding centers. It is encouraging that women's options are on the rise and that the system is better at meeting the needs and values of women. But many more women should have access to evidence-based options.

Passing the midwifery birth center bill would take us a step closer to that goal.

Michele Giordano and Nan Strauss are, respectively, executive director and director of policy and research at Choices in Childbirth, a nonprofit organization.